EPIC-26 urinary incontinence score results and pad use 12 months after radical prostatectomy for localized or (locally) advanced prostate cancer: Results of a cohort of 14,920 patients from 118 certified centers in Germany, Switzerland, and Austria.
Authors: Peter Hammerer, Nora Tabea Sibert, Clara Breidenbach, Pierre Tennstedt, Thomas Steiner, Thomas Knoll, Boris A. Hadaschik, Moritz Johannes Reike, Elisabeth Bartolf, Thomas Wiegel, Vanessa Kolb, Ernst-Günther Carl, Günter Feick, Sebastian Dieng, Gregor Duwe, Simone Wesselmann, Christoph Kowalski
Journal: Journal of Clinical Oncology (2023)

e17102 Background: Besides erectile dysfunction, urinary incontinence is the most common functional impairment after radical prostatectomy (RP) for localized and (locally) advanced prostate cancer (PCa). Clinical guidelines recommend informing patients about incontinence and other functional impairment of the different therapy options. Yet, real-world data on incontinence following RP is sparse in most countries, impeding the information of patients. This work aims to present data on urinary incontinence after RP from routine care in Germany, Switzerland and Austria using the EPIC-26 urinary incontinence score and the single item on pad use. Methods: We analyzed data from the prospective cohort study PCO (Prostate Cancer Outcomes Study), partly funded by the Movember Foundation. The data presented was based on patients treated with RP for localized and (locally) advanced PCa in one of 118 Certified Prostate Cancer Centers between 2016 and 2021. The Berlin Medical Association's ethics board and local ethics boards approved the study. Each patient gave informed written consent. Patients included in the analytic sample had to complete a baseline questionnaire (EPIC-26) before (T0) and a follow-up questionnaire 12 months after RP (T1). Questionnaire data were linked to clinical data and analyzed descriptively: We report changes in the urinary incontinence score between T0 and T1 and the proportion of patients using pads ("pad use") stratified by age and risk group according to the German clinical guideline (based on the d’Amico risk groups). Results: 14,920 patients from 118 centers were included in the analysis. The median age was 66 (interquartile range 61-70). The average urinary incontinence score (value range: 0 - worst possible to 100 - best possible) was 93 points at T0 and 73 points 12 months later. 97% of the patients did not use pads at T0, compared to 57% using at least one pad per day at T1. Among patients who did not use pads at T0, 42% used at least one pad a day 12 months later, and 12% used two or more pads per day. The proportion of patients using pads differs meaningfully according to age and risk group and across centers. Conclusions: The data presented gives insight into real-world functional outcomes after RP. These results may help inform providers and patients when discussing treatment options in an easy-to-understand way. Availability of comparable data from other countries is limited, with Australian registry data suggesting slightly better outcomes at 12 months. Results are limited to Prostate Cancer Centers certified according to the requirements of the German Cancer Society. They are thus a selection of units with at least 50 RPs per year and many other quality standards met.